1. Field of the Invention
The invention relates to a hysteroscope for carrying out endoscopic operations in the uterus by way of an auxiliary instrument. The hysteroscope includes an inner shank and an outer shank surrounding the inner shank whilst forming a longitudinal channel, a first fitting for supplying rinsing fluid to be led through the inner shank into the uterus, a second fitting for removing rinsing fluid from the uterus via the longitudinal channel, a third fitting at which the auxiliary instrument is introducable into the hysteroscope and is further distally movable through a working channel, and of deflection means with which the distal end region of the auxiliary instrument is elastically laterally deflectable.
2. Description of the Related Art
With such operation hysteroscopes e.g. with the help of forceps and laser probes as auxiliary instruments, myonlas on or in the uterus wall are removed, and specifically with the simultaneous rinsing of the body cavity in order to ensure a good viewing of the operational region by way of optics running through the endoscope. There is also required a lateral deflection of the distal end of the end section of the auxiliary instrument, which projects out of the endoscope, in order to be able lead the end of the auxiliary instrument freely and unhindered to the operation location.
The deflection with the use of flexible auxiliary instruments is not problematic and may be carried out with a pivotable lever located distally on the endoscope, also called an Albarran lever. A lateral deflection of the distal auxiliary instrument by way of a ramp is also possible (U.S. Pat. No. 2,129,391 and U.S. Pat. No. 5,947,994).
This however does not function with semi-rigid or relatively rigid auxiliary instruments since for their deflection relatively large bending forces are required which may not be mustered by a pivotable lever or deflection element without supporting measures. Although an elastic deflection of relatively rigid end sections of auxiliary instruments via the oblique surface of a ramp is possible, the ramp however may not be too steep since otherwise the auxiliary instrument may not be slid over the ramp or only with a destructive force. Furthermore, a ramp with a relatively low inclination may lead to the disadvantage that the auxiliary instrument end may not be deflected laterally enough.
The object of the invention lies in the solution of these problems. Furthermore there is to be put forward a hysteroscope which to a great extent may be disassembled for cleaning purposes and which has a favorable design of the respective fittings for the supply and removal of the rinsing fluid as well as for introducing the auxiliary instrument.
For achieving this object the hysteroscope according to the invention has a first ramp on which, sliding up, the distal end of the auxiliary instrument moved distally through the hysteroscope is deflectable in order with a further distal movement of the auxiliary instrument to bring its distal end region into a first position. There is also provided a deflection element with which the distal end region of the auxiliary instrument is deflectable into a second position beyond the first position, and specifically to a greater or lesser degree as required.
The first ramp may in principle be designed relatively-flat with a low gradient so that the distal auxiliary instrument end may be pushed easily over the ramp and deflected into its first position by bending, which may be considered as a supporting and preparatory measure for further deflection into a second position by pivoting out the deflection element, since this is possible without an excess force effort, after the distal end region of the auxiliary instrument has already been brought into an intermediate position by the ramp.
The deflection element designed as a pivotably mounted lever by way of a distal displacement out of a rest position, with a second ramp is pivoted against the distal end region of the auxiliary instrument in order to deflect this end region into the second position. With this the pivot bearing of the deflection element is usefully axially displaced with two parallel actuation rods which run through stationary guides which are attached at the outside on the inner shank and whose distal ends blend into a transverse web which runs through parallel slots into guides parallel to one another and likewise attached on the outside and on the inner shank, and which forms the pivot pin of the deflection element.
The ability of a hysteroscope of this or another type to be disassembled more easily amongst other things is achieved by designing the second fitting as a rinsing attachment, at the proximal end of the outer shank there is provided a coupling part with a cone, and the rinsing attachment may be placed from the proximal onto the cone, is displaceable proximally further onto the coupling part and is rotationally connectable to the coupling part in a manner lying against an abutment.
The rinsing attachment is equipped with a slotted clamping ring whose limbs on pushing onto the cone are elastically spread open and after the complete pushing of the rinsing attachment onto the coupling part under return deformation engage into an annular groove on the coupling part in order thus to fix the rinsing attachment by way of a positive fit connection. Furthermore on the coupling part there is provided a further annular groove which in cooperation with an annular housing part of the mounted rinsing attachment forms an annular channel which on the one hand is in connection with the channels of the rinsing attachment which lead the rinsing fluid and on the other hand via bores in the coupling part is in connection with a channel between the inner shank and the outer shank.
A useful connection of the two shanks results when in the coupling part there is provided a cone receiver into which from the proximal there may be pushed a coupling cone which is seated on the inner shank and which by way of latching elements is releasably connected to the coupling part.
Furthermore proximally to the coupling cone there may be a handle on whose proximal end there is provided a first fitting whose parts supplying the rinsing fluid via an obliquely proximally running channel are in connection with the channel forming the inner shank. Furthermore on the proximal end of the handle there may be provided a coupling with which optics insertable into and through the inner shank may be fastened on the inner shank.
The ability of a hysteroscope to be disassembled for cleaning purposes may furthermore be achieved by equipping the third fitting, on which the auxiliary instrument is introduced into and through the working channel of the hysteroscope, with a quick change valve which has a longitudinal channel for leading through the auxiliary instrument. This is partly inserted into a connection piece and by way of a bar may be fastened in the connection piece.
The quick change valve is on the distal side equipped with an elastic, centrally apertured sealing disk and proximally on its introduction connection piece projecting out of the connection piece is provided with a sealing cap which is placed provided centrally at the proximal end with an aperture through which the auxiliary instrument via the valve longitudinal channel further through the apertured sealing disk may be distally pushed into a working channel.
The fixing of the quick change valve in the connection piece may be effected such that the bar displaceable transversely to the longitudinal channel of the valve, in a locking position with two oppositely lying limbs on both sides engages with a positive fit into a groove on the quick change valve, and that by displacing the bar into a release position the positive fit is lifted and the quick change valve may be pulled from the connection piece.